Peyronie's disease
In Peyronie's disease the penis bends during an erection because a patch of scar has formed in its outer sheath.
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Medicines commonly prescribed for Peyronie's disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 50 mgActive substance: sildenafilManufacturer: Ratiopharm GmbhPrescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 12.5 mg/puffActive substance: sildenafilManufacturer: Aspargo Labs Italia S.R.L.Prescription requiredDosage form: TABLET, 50 mgActive substance: sildenafilManufacturer: Viatris LimitedPrescription required
In Peyronie's disease the penis bends during an erection because a patch of scar has formed in its outer sheath. At rest it can look entirely normal, which is why men often take a long time to work out what is happening: first erections hurt, then a firm area can be felt under the skin, and only then does the bend appear. It is a common condition — around one man in twenty has it, most often after the age of forty — and the single most useful thing to know is that surgery must not be rushed, while the appointment should not be put off, because the stage of the disease decides which treatment makes sense.
What is going on inside
Inside the penis lie two corpora cavernosa, spongy cylinders that fill with blood. Each is wrapped in a tough sheath, the tunica albuginea, which is elastic, stretches during an erection and holds the pressure in. When a patch of scar, a plaque, forms in that sheath, that part loses its ability to stretch. The rest of the sheath stretches as before, so on erection the penis pulls towards the plaque: on the upper surface it bends upwards, on the underside downwards, at the side it bends sideways.
A plaque is not always a single spot. When it runs round the shaft as a band, the middle is nipped in during erection like an hourglass, and the penis can hinge there under load — enough to interfere even without a marked bend. Over time the scar shortens the side it sits on, and the overall erect length decreases.
What men notice
The complaints usually arrive in this order:
- painful erections, often the very first sign: a dull, dragging pain that builds as the penis fills;
- a firm cord or lump under the skin, felt when the penis is soft, most often on the upper surface of the shaft;
- a bend during erection that gradually increases;
- narrowing or a waist in the middle, the hourglass shape;
- shortening;
- difficulty with penetration and with sex itself, including pain for a partner;
- weaker erections, sometimes from the disease itself and sometimes from anxiety about sex.
A slight natural curve is common and is not a disease. What matters is a curve that is new and changing, a firm area that can be felt, an erection that hurts, or a penis that has become difficult to use.
In some men with Peyronie's disease the skin and tendons thicken elsewhere too: Dupuytren's contracture develops in the palm and stops the fingers straightening, and less often firm nodules appear in the arch of the foot. This is not coincidence but the same tendency of connective tissue to scar excessively.
Active and stable phases: the crucial distinction
The disease runs in two stages, and which one you are in decides quite literally everything.
The active phase lasts somewhere between six and eighteen months. During it there is pain, and the angle changes from month to month, usually for the worse. Operating then is not an option: the scar is still forming, and the result of surgery would drift along with the disease.
The stable phase arrives once the pain has gone and the angle has not moved for several months. Only then is surgery discussed. The working rule is at least a year since the start and at least three to six months without change.
Left alone, the bend usually does not go away: around one man in ten improves over time, half stay as they are, and the rest slowly get worse. Waiting and watching is therefore reasonable during the active phase, but not indefinitely and not instead of seeing a doctor.
When help is needed urgently
Peyronie's disease settles in over weeks and months, so anything that happens suddenly is a different story with a different urgency.
- A crack or snap during sex, the erection collapsing instantly, the penis swelling and turning purple, with severe pain: that is a penile fracture, a rupture of the tunica albuginea. It needs emergency care within the hour, because such a tear is usually repaired within the first day and, left alone, also leaves a marked bend behind.
- An erection that will not go down after more than four hours and has become painful is priapism. Also an emergency: the longer the blood stays trapped, the greater the risk of losing erections permanently.
- A firm lump, a sore or a non-healing patch on the glans or foreskin is not Peyronie's disease and needs to be looked at within days.
Across much of Europe the single emergency number is 112; elsewhere use your local emergency number. In every other situation an ordinary appointment is enough.
Why it develops
The accepted explanation is repeated microtrauma. During sex the sheath tears now and again on a microscopic scale, and normally this heals without trace. In some men the repair lays down too much collagen and a scar is left at that point. Very few recall a single heavy injury; more often the start cannot be tied to any particular episode at all.
It is more likely if there is:
- Dupuytren's contracture or similar thickening in the foot, including in relatives;
- diabetes;
- high blood pressure, high cholesterol, arteriosclerosis;
- smoking;
- previous prostate surgery;
- low testosterone.
Older accounts listed beta blockers and some antidepressants among the risk factors. There is no convincing evidence for this and, more to the point, such medicines must never be stopped on your own initiative: beta blockers are withdrawn only gradually and to a plan, because stopping abruptly can bring a surge in blood pressure, a racing pulse and an attack of angina. The same applies to antidepressants, which are tapered slowly. If you suspect a link, that is something to raise with your doctor, not a reason to stop taking the tablets.
What else it could be
Not every curved penis is Peyronie's disease. A congenital curve is noticeable from the first erections in adolescence, the sheath is smooth, there is no lump and no pain, and it is managed differently. After a penile fracture there is a scar at the site of the tear and a bend, but the onset was instantaneous and hard to forget.
A hard cord under the skin on the upper surface that appears a day or two after prolonged or vigorous sex is usually thrombosis of a superficial vein: it settles by itself over a few weeks and leaves no curvature. Sclerosing lymphangitis can feel much the same. Finally, any firm lump on the glans or foreskin, especially one that ulcerates, has nothing to do with this condition and needs assessing in its own right.
What happens at the appointment
There is no reason for embarrassment: it is a common reason to attend and doctors hear about it regularly. The conversation starts with the history — when it began, whether there was an injury, whether the angle has been changing, whether erections hurt now, and what exactly is getting in the way during sex.
Then comes the examination. With the penis soft, the doctor feels the shaft, finds the plaque, judges its size and position and measures the length under gentle stretch. The angle cannot be judged from a description, so photographs taken at home with the penis erect, from above and from the side, with something for scale, are genuinely useful. The alternative is to produce an erection in the clinic with an injection and measure the angle there.
A doppler ultrasound scan shows the plaque, any calcium in it and, at the same time, the blood flow — the last of these matters when erections are a problem, because whether straightening will help depends on why they are failing. If there is erectile dysfunction, blood glucose, lipids and testosterone are checked. Neither blood tests nor an MRI scan are needed for the diagnosis itself: it is made on examination.
What is done while the disease is active
If the bend is slight, nothing hurts and sex is unaffected, there is nothing to treat and the situation is simply kept under review.
In the active phase the aim is to relieve pain and, as far as possible, stop the scar growing. The pain usually settles by itself over a few months; the painkiller is chosen with a doctor, bearing in mind that anti-inflammatory drugs taken long term are hard on the stomach and the kidneys and sit badly with anticoagulants. The tablets offered for decades to "dissolve the plaque" have not shown convincing benefit in trials and are not worth relying on. Two approaches are genuinely used: injecting a drug straight into the plaque (depending on the country this may be an enzyme that breaks down collagen, or a drug from the calcium channel blocker group) and traction, using purpose-made devices or vacuum devices worn several hours a day for many months. Shockwave therapy eases pain but does not straighten the angle, and promising otherwise is simply untrue.
Surgery and what it can achieve
In the stable phase, if the bend interferes with sex, an operation is considered. There are three kinds. Folding and stitching the longer side is the simplest and most dependable, but the penis ends up shorter. Cutting out the plaque and filling the gap with a graft preserves length and is used for large angles and for waisting, though it worsens erections more often and reduces sensation. If erections have already failed before any surgery, a prosthesis is fitted, which straightens the penis at the same time. The surgeon should set out in advance the likely loss of length, the risk of altered sensation, and the fact that a completely straight penis is not the usual outcome.
Erection problems are treated separately, generally with tablets from the PDE-5 inhibitor group. They cannot be combined with nitrates, so your doctor needs to know everything you take. One last point: Peyronie's disease hits self-esteem and relationships harder than it hits anatomy. Talking about that is part of treatment rather than a sign of weakness, and it is worth bringing a partner into the conversation.
Online consultation
Starting online is convenient. At the appointment a doctor goes through your history, helps separate a recent curve from a congenital one, works out from the timing and your photographs whether the active phase is still running or the disease has settled, and explains why in the first case it is too early for a surgeon and in the second it is exactly the right moment. The same appointment can cover how to take the photographs properly and keep a record of changes, which results to bring to a face-to-face visit, what to do about erections and how that fits with the medicines you already take. Examination and measuring the angle will still need someone in the room, but you will arrive prepared and without extra months of waiting.
This material is for information only and does not replace medical advice.
Consult with a doctor about Peyronie's disease
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Peyronie's disease
Discuss your symptoms and possible next steps for Peyronie's disease with a doctor online.
